Document Type : Original Article
Authors
- . Mohammadjavad Hosseinabadi‑Farahani1 1
- . Masoud Fallahi‑Khoshknab 1
- . Narges Arsalani 1
- . Mohammadali Hosseini 1
- . Eesa Mohammadi 2
1 Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,
2 Department of Nursing, Faculty of Medical Sciences, University of Tarbiat Modares, Tehran, Iran
Abstract
BACKGROUND: Discrimination in health care is a common phenomenon whose complete
understanding has always been a major concern of health-care systems to control and reduce it.
This study aimed to explore the experiences of unintentional discrimination and related factors in
health-care providers.
MATERIALS AND METHODS: This qualitative study was conducted with a content analysis approach
in 2019. Data were collected through semi-structured interviews with 13 health-care providers including
two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides
in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling.
The obtained data were analyzed by Graneheim and Lundman method.
RESULTS: Three main categories and eight subcategories were obtained from the data
analysis: (1) forced discrimination (superiors’ pressures and executive orders, occupational concerns,
and fear of the superiors); (2) guided discrimination (professional challenges, managers’ policymaking,
and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of
medical equipment).
CONCLUSION: The results of this study suggest that health-care providers such as doctors and
nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and
managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing
the factors that lead to superiors’ pressures and occupational forces and improving the medical ethics
knowledge should be considered by health-care managers.
Keywords
- Nguyen TT, Vable AM, Glymour MM, Nuru‑Jeter A. Trends for
reported discrimination in health care in a national sample of older
adults with chronic conditions. J Gen Intern Med 2018;33:291‑7.
2. Whitaker KM, Everson‑Rose SA, Pankow JS, Rodriguez CJ,
Lewis TT, Kershaw KN, et al. Experiences of discrimination
and incident type 2 diabetes mellitus: The multi‑ethnic study of
atherosclerosis (MESA). Am J Epidemiol 2017;186:445‑55.
3. Abramson CM, Hashemi M, Sánchez‑Jankowski M. Perceived
discrimination in U.S. healthcare: Charting the effects of key
social characteristics within and across racial groups. Prev Med
Rep 2015;2:615‑21.
4. Versey HS, Curtin N. The differential impact of discrimination on
health among Black and White women. Soc Sci Res 2016;57:99‑115.
5. Parker LJ, Hunte H, Ohmit A. Discrimination in health care:
Correlates of health care discrimination among black males. Am
J Mens Health 2017;11:999‑1007.
6. Brondolo E, Brady Ver Halen N, Pencille M, Beatty D, ContradaRJ.
Coping with racism: A selective review of the literature
and a theoretical and methodological critique. J Behav Med
2009;32:64‑88.
7. KaganSH. Ageism in cancer care. Semin Oncol Nurs 2008;24:246‑53.
8. Perreira KM, Telles EE. The color of health: Skin color, ethnoracial
classification, and discrimination in the health of Latin Americans.
Soc Sci Med 2014;116:241‑50.
9. Barber C. Disability discrimination in healthcare services and
employment. Nurs Stand 2015;30:40‑5.
10. Ginsburg OM. Breast and cervical cancer control in low and
middle‑income countries: Human rights meet sound health
policy. J Cancer Policy 2013;1:e35‑41.
11. Piette JD, Bibbins‑Domingo K, Schillinger D. Health care
discrimination, processes of care, and diabetes patients’ health
status. Patient Educ Couns 2006;60:41‑8.
12. van den Heuvel WJ, van Santvoort MM. Experienced
discrimination amongst European old citizens. Eur J Ageing
2011;8:291‑9.
13. Rodríguez‑Álvarez E, González‑Rábago Y, Borrell LN,
Lanborena N. Perceived discrimination and self‑rated health in
the immigrant population of the Basque Country, Spain. Gac Sanit
2017;31:390‑5.
14. Sweiry DW. Attitudes to Age in Britain 2010/11. In: House
Research no 7. London: Department for Work and Pensions; 2012.
15. Fernandez‑Ballesteros R, Olmos R, Santacreu M, Bustillos A,
Molina MA. The role of perceived discrimination on active aging.
Arch Gerontol Geriatr 2017;71:14‑20.
16. Wofford N, Defever AM, Chopik WJ. The vicarious effects of
discrimination: How partner experiences of discrimination affect
individual health. Soc Psychol Personal Sci 2019;10:121‑30.
17. Board UP, editor. Zero Discrimination in Health Care Settings.
Geneva, Switzerland: 2017.
18. Nivaldo Linares‑Péreza OL. Health equity: Conceptual models,
essential aspects and the perspective of collective health. Soc Med
2008;3:194‑206.
19. Haydt SM. Politics and professions: Interdisciplinary team models
and their implications for health equity in Ontario. Int J Health
Serv 2018;48:302‑27.
20. Curtis LJ, MacMinn WJ. Health care utilization in Canada:
Twenty‑five years of evidence. Canadian Public Policy
2008;34:65‑87.
21. Campesino M, Saenz DS, Choi M, Krouse RS. Perceived
discrimination and ethnic identity among breast cancer survivors.
Oncol Nurs Forum 2012;39:E91‑100.
22. Etieyibo E, Omiegbe O. Religion, culture, and discrimination
against persons with disabilities in Nigeria. Afr J Disabil
2016;5:192.
23. Yasui M, Dishion TJ, Stormshak E, Ball A. Socialization of culture
and coping with discrimination among American Indian families:
Examining cultural correlates of youth outcomes. J Soc Social
Work Res 2015;6:317‑41.
24. Martin SS, Trask J, Peterson T, Martin BC, Baldwin J, Knapp M.
Influence of culture and discrimination on care‑seeking behavior
of elderly African Americans: A qualitative study. Soc Work
Public Health 2010;25:311‑26.
25. Shepherd SM, Willis‑Esqueda C, Paradies Y, Sivasubramaniam D,
Sherwood J, Brockie T. Racial and cultural minority experiences
and perceptions of health care provision in a mid‑western region.
Int J Equity Health 2018;17:33.
26. Hsieh HF, Shannon SE. Three approaches to qualitative content
analysis. Qual Health Res 2005;15:1277‑88.
27. Graneheim UH, Lundman B. Qualitative content analysis in
nursing research: Concepts, procedures and measures to achieve
trustworthiness. Nurse Educ Today 2004;24:105‑12.
28. Kligyte V, Connelly S, Thiel C, Devenport L. The influence of
anger, fear, and emotion regulation on ethical decision making.
Hum Performance 2013;26:297‑326.
29. Dehghani A, Mosalanejad L, Dehghan‑Nayeri N. Factors affecting
professional ethics in nursing practice in Iran: A qualitative study.
BMC Med Ethics 2015;16:61.
30. Kaabomeir N, Mosavi M, mosavi S, Naami A. Assessing
relationship between intra organizational factors that affect
on nurses’ professional ethics behaviors. Q J Nurs Manage
2018;7:9‑17.
31. Habibzadeh H, Ahmadi F, Vanaki Z. Facilitators and Barriers to
the Professionalization of Nursing in Iran. Int J Community Based
Nurs Midwifery 2013;1:16‑25.
32. Mahajan R, Aruldhas BW, Sharma M, Badyal DK, Singh T.
Professionalism and ethics: A proposed curriculum for
undergraduates. Int J Appl Basic Med Res 2016;6:157‑63. - 33. Imran N, HaiderI, Jawaid M, Mazhar N. Health ethics education:
Knowledge, attitudes and practice of healthcare ethics among
interns and residents in Pakistan. J Postgrad Med Institute
2014;28:383‑9.
34. Bostani S. Strategies to promote professional ethics in nursing
education system. Dev Strategies Med Educ 2015;2:13‑22.
35. Aacharya R, Shakya Y. Knowledge, attitude and practice of
medical ethics among medical intern students in a Medical
College in Kathmandu. Bangladesh J Bioethics 2016;6:1.
36. Ludwick R, Silva MC. Errors, the nursing shortage and ethics:
Survey results. Online J Issues Nurs 2003;8:9.
37. Shamsi A, Peyravi H. Nursing shortage, a different challenge in
Iran: A systematic review. Med J Islam Repub Iran 2020;34:8.
38. Yun H, Jie S, Anli J. Nursing shortage in China: State, causes, and
strategy. Nurs Outlook 2010;58:122‑8.
39. Borhani F, Abbaszadeh A, Mohamadi E, Ghasemi E,
Hoseinabad‑Farahani MJ. Moral sensitivity and moral distress
in Iranian critical care nurses. Nurs Ethics 2017;24:474‑82.
)